The Role of Laparoscopic Necrosectomy in the Era of Minimally Invasive Treatment for Necrotizing Pancreatitis: A Case Series and Review of the Literature

PURPOSE: Despite the recent increasing application of minimally invasive techniques to treat necrotizing pancreatitis, few reports on laparoscopic necrosectomy have appeared. The aim of the present study was to evaluate the role played by laparoscopic necrosectomy in treatment of necrotizing pancreatitis. We review our own experience and the relevant literature. METHODS: All patients undergoing laparoscopic necrosectomy at Seoul National University Bundang Hospital from March 2005 to January 2016 were included in the study. Data on patient demographics, CT severity index score, American Society of Anesthesiologists' score, preoperative procedures, operative methods, operation time, estimated blood loss, postoperative complications, and length of hospital stay were retrospectively analyzed. We also performed an up-to-date review of the relevant literature. RESULTS: Laparoscopic necrosectomy was performed on four patients with infective pancreatic necrosis that was inadequately treated by percutaneous drainage. A transgastrocolic, transmesocolic, or retrocolic approach was used. The median time from diagnosis to operation was 57 days (range, 34~109 days) and the median operation time 203 min (range, 180~255 min). There was no operative mortality. The necrotic tissue was successfully removed in a single operation in three of the four patients. Three patients experienced postoperative complications, including pleural effusion and recurrence of necrosis. The median postoperative hospital stay was 39 days (range, 16~99 days). CONCLUSION: Laparoscopic necrosectomy is safe and effective when used to treat necrotizing pancreatitis. Such treatment is especially useful for patients with solid, necrotic pancreatic components that are not removed by percutaneous or endoscopic drainage.

Solo Three-incision Laparoscopic Cholecystectomy Using a Laparoscopic Scope Holder for Acute Cholecystitis

PURPOSE: L aparoscopic cholecystectomy (LC) i s a c ommonly p erformed procedure for t he management of acute cholecystitis. The presence of an inexperienced scopist or a shortage of manpower could be problematic in emergency surgical cases. To overcome these potential problems while ensuring a stable surgical view during LC, we performed solo surgery. METHODS: We retrospectively reviewed the results of 22 patients who underwent solo three-incision LC (S-TILC) and 31 patients who underwent the conventional three-incision LC (C-TILC) from March 1, 2015, to August 31, 2015. We compared the two groups with respect to the patients' clinical characteristics, and intraoperative and postoperative results; and severity grade as defined by the updated Tokyo guidelines 2013 (TG13) criteria. RESULTS: No significant differences in baseline characteristics were found between the two groups. The intraoperative perforation rates were higher in the C-TILC group than in the S-TILC group (p=0.016). Two cases were converted to human-assisted LC in the S-TILC group because of severe adhesions and the scope holder breaking down. No significant differences were found between the groups with respect to length of hospital stay; postoperative diet habit; or rates of post-cholecystectomy diarrhea, abdominal pain, wound complication, or complication according to the Clavien-Dindo grade. CONCLUSION: S-TILC and C-TILC were comparable in terms of results, and this solo surgery in LC could be performed for cases of acute cholecystitis during shortage of skilled manpower.